It is possible that the entire healing relationship is actually founded on friendship. - Saki Santorelli
Be kind whenever possible. It is always possible. Dalai Lama
This section lists a series of loosely linked handouts and questionnaires about compassion, self-criticism, hostility, self-esteem and related subjects. Compassion is an area that is being actively researched at the moment from a series of overlapping angles. Here in the UK, Paul Gilbert's work is probably the best known. His focus has partly been on the damaging effects of excessive self-criticism (for example in vulnerability to depression) and the potential benefits of promoting self-compassion. In the States, Kristin Neff has been a leading researcher on self-compassion - see for example her Self-compassion website and list of freely downloadable publications. I think both these authors would argue that self-compassion may often be a preferable way to relate to oneself rather than focusing too much on boosting self-esteem. Other research - for example, by Mark Leary & colleagues - has further supported this view. From different traditions, more emotion-focused investigators have looked at self-criticism using approaches such as internal dialogue exploration - see the Emotions, feelings & personality handouts webpage.
Other research teams have come at compassion from varying viewpoints. Barbara Fredrickson looked at how loving-kindness meditation boosts positive emotions, leading to better functioning and increased life satisfaction. James Carson explored possible benefits for people suffering from chronic pain. From a rather different angle, Jennifer Crocker at Michigan's Self & Social Motivation laboratory has explored how compassion impacts on relationships with others as well as oneself. Also relevant here are the posts "Cooperative behaviour cascades in social networks" and "Be the change you want to see in the world". See too interesting work on implications of research on intercessory prayer. More in the public domain, Buddhist teachers like Sharon Salzberg have published quite extensively on loving-kindness meditation, and there are further groups like the Random Acts of Kindness Foundation. All in all, although the field cries out for more research (and possibly more over-arching theory), we seem to have reached a stage where one can say there are real benefits for people who develop both greater self-compassion and greater compassion for others.
Self-compassion scale - long form (Neff) with scoring and research - Kristin Neff's self-compassion scale can be helpful in assessing various aspects of self-compassion. It can be a little time consuming to score, so may be best to work with just occasionally during therapy - or use the short form (below).
Self-compassion scale - short form (Raes, Neff, et al) - downloadable both as a Word doc and as a PDF file. I find this 12-item short form of the self-compassion scale very convenient. It's quicker & easier to complete & score than the long form, making it much more likely that one will use it to monitor treatment effectively. The total score of the short form correlates very well with the total score for the long form. It's probably better to use the long form if one wants to focus on sub-scale scores. See Kristin Neff's list of freely downloadable publications on the web for more information about these scales and her work generally.
4 item scale, self-criticism & self-compassion - I find the Neff self-compassion scale a bit too long and slow to score for week by week use. This simple self-constructed 4 item scale can be helpful in keeping an eye on how things are going session by session, while the fuller Neff scale is only being used occasionally. Here is the scale as a PDF too.
Toxicity of self-criticism abstracts - a chronic self-critical, self-attacking attitude is toxic to our wellbeing. Sometimes this damaging attitude to ourselves seems to be associated with difficulties in childhood, including poor care from our parents (possibly due to their own depression) and bullying from other children. This handout gives research abstracts that illustrate these points.
Toxicity of hostility abstracts - persistent anger, hostility & cynicism are damaging - not only to those at the receiving end but also to those who repeatedly feel these emotions. This handout details some research studies highlighting these connections.
Undoing the brainwashing, slides 1 & 2 and slides 3 & 4 - here are 4 slides (usually printed out as 2 slides to a page handouts) that illustrate ideas from Paul Gilbert's compassionate mind training. Slides 3 & 4 particulary are from Paul's work on how the way one is treated by external harsh critics (e.g. parents, etc) can be 'ingested' and become a way that one views and treats oneself.
Moods affect us quickly & powerfully - here is a nice two slides to a page handout illustrating the rapid effects of hostility and of compassion on mind and body.
Assessment of self-critic (or self-scarer) dialogue work - this is a questionnaire I put together to encourage client reflection after they have worked with forms of two-chair dialogue involving their internal self-critic (or self-scarer for anxiety disorders).
Post-imagery rescripting questionnaire - and this form is similar to the one above, but used more after work on specific memories (rather than after dialogue work) - for example using Mervyn Smucker style rescripting.
Compassionate/self-image goals scale and background - this is a scale from Crocker's fascinating work on compassionate and self-image goals. See too the "Self and social motivation laboratory" website at http://rcgd.isr.umich.edu/crockerlab
Contingencies of self-worth scale - this is another questionnaire from the Crocker lab (see above). Interesting way of probing what people's self-worth is based on ... and what the subsequent effects then are.
Nourishing self-esteem background - people who are low in self-esteem are often in the paradoxical position of really wanting to feel appreciated & validated by others, but finding it hard to believe that compliments genuinely mean that they are valued in any lasting way. This handout gives background to an exercise that teaches people with low self-esteem ways of allowing appreciation to touch and help them more.
Nourishing self-esteem exercise - here are more details of the exercise that encourages people with low self-esteem to allow compliments and appreciation to help them.
Boosting self-compassion & self-encouragement by strengthening attachment security: twelve practical suggestions - these two blog posts and the associated downloadable handout does "what it says on the tin" in providing some practical exercises that can be used to nourish our self-compassion.
5 stages of change & associated processes - this is the trans-theoretical stages of change model of Prochaska, DiClemente & Norcross. It can be used to explain step-by-step change in many different behaviours. It can useful when encouraging people to move from a habit of self-criticism to one on self-encouragement.
Development of caring in health professionals - here are a couple of research abstracts on caring in nurses linking this central quality with the nurses' experience of caring from their parents and from their nursing school. The latter was particularly important, raising a series of questions about the knock-on effects of less caring institutions that train health professionals.
3 facet mindfulness questionnaire and discussion - this is a three component, cut-down version of the 5 facet questionnaire (see below). I like this scale partly because it highlights the importance of reducing internal self-judgement in mindfulness.
There are a dozen MP3 recordings listed below. It would be possible to use these tracks as a "compassionate mind training" sequence, although I've listed them more to illustrate the kind of approach that it's probably sensible to use. The twelve recordings make up a four exercise training. Each exercise includes a brief (1 to 3 minute) introductory track and then a medium length (15 to 18 minute) and longer (24 to 28 minute) meditation. If you want to follow this sequence, please read the Suggestions for goodwill practice handout (below) first.
There are a number of caveats. I initially made these home recordings for people who had already completed the 8 x 2 hour Autogenic Training courses that I run. Autogenic Training is a form of deep relaxation training. It makes good sense to relax and quieten before moving on to the Goodwill exercises - hence the Autogenic exercise that precedes the Goodwill section on each of the meditations. If you haven't already trained in Autogenics, the approach may seem a little strange at first. It basically consists of moving one's attention through the different body systems - limbs, circulation, breathing, digestion, etc - settling them down. The way I teach is somewhat unusual. I have been practising forms of meditation most days of the week since 1970, so I have a fair amount of experience. The recordings consist of me sitting quietly going through the meditation practice myself and sharing what I am focusing on as I do this. The quality of the recordings isn't great, partly because they are simply made at home, and partly because I have reduced the size of the files by a factor of about six to allow them to be downloaded more easily and quickly.
For various partly evidence-based reasons, I encourage the Goodwill focus to be quite "emotional" rather than "cerebral". I also encourage longer practice sessions where possible, although each meditation is also given as a somewhat shorter "medium length" practice. Many people find that allowing compassion for themselves is particularly tricky - hence the sequence beginning with someone it feels relatively easy to feel love for, then moving on to family & friends in the second exercise, before reaching a focus on oneself too in the third exercise. The fourth exercise then moves to include "all living beings". Typically I encourage people to use each exercise over at least a week or two, before moving on to the next exercise in the sequence. Particularly for people with high levels of self-criticism, I might suggest that they keep returning to the third exercise's compassion for oneself focus, rather than always using the fourth exercise.
It is worth noting that there are a whole series of ways to nourish a greater sense of compassion for others, and for oneself. Much of the recent research has explored how to encourage self-compassion to combat the self-criticism that is a significant risk factor for depression. Goodwill, loving kindness and compassionate mind meditation interventions are one approach that can be useful. Psychotherapeutic two chair dialogue work (with the self-critic), challenging "brainwashing" from traumatic childhood experiences, building wellbeing through increasing competence & relatedness, experiencing real care in a good therapeutic relationship, and other approaches can all also be helpful in changing chronic patterns of self-criticism and hostility.
A final technical point. It's a little difficult to make MP3 files available for download on the internet due to understandable concerns about illegal distribution of potentially copyrighted material. I've got round this by joining MySpace as a band! This allows me to upload MP3 files to a site where they can be a source for subsequent downloads. I'm sure there are more elegant ways of getting round this, but I'm tickled to present myself as a rock band (frustrated ambitions of youth!). When you click on one of the meditation track links, it will hopefully take you to the site where - by clicking on the named file - you can either open and play the file directly or save it to listen to later.
Suggestions for goodwill practice - this is a three page handout that I give clients who are learning goodwill/loving kindness/compassionate mind training with me. It contains references to various aspects of my work that probably aren't relevant to the situation with other teachers. However the vast majority of the handout is either directly relevant to, or easily adapted to, goodwill meditation trainings provided by other trainers.
Goodwill practice record - this is a simple weekly practice record for goodwill/loving kindness/compassionate mind training. It should be pretty easy to adapt this for the particular formats used by other trainers.
Goodwill & Autogenics 1: introduction - this is a brief 3 minute MP3 file introducing the initial practice. There are fuller details in the written Suggestions handout (see above).
Goodwill & Autogenics 1: 16 minutes - this initial exercise begins with an Autogenic Training relaxation and moves on to a Goodwill practice focusing on somebody that one feels particularly caring for.
Goodwill & Autogenics 1: 28 minutes - a longer version of the meditation exercise given above. There is some evidence suggesting that longer practices are more helpful, but there needs to be more research before one could make firm recommendations about this issue of duration.
Goodwill & Autogenics 2: introduction - briefly introduces the second exercise.
Goodwill & Autogenics 2: 17 minutes - again an initial Autogenic relaxation is followed by a Goodwill practice, now extending from somebody one feels particular caring for to also include friends and family.
Goodwill & Autogenics 2: 24 minutes - a longer version of the meditation given above.
Goodwill & Autogenics 3: introduction - briefly introduces the third exercise.
Goodwill & Autogenics 3: 15 minutes - an initial Autogenic Training exercise followed by a Goodwill practice that adds a focus on oneself to the mix. This is probably especially relevant for people who suffer from excessive self-criticism and vulnerability to depression. Interestingly there may also be relevance - as self-soothing - for people who struggle with anxiety.
Goodwill & Autogenics 3: 24 minutes - a longer version of the meditation given above.
Goodwill & Autogenics 4: introduction - briefly introduces the fourth exercise.
Goodwill & Autogenics 4: 18 minutes - Autogenic relaxation followed by a Goodwill practice that moves through the sequence from somebody one especially cares for, to friends & family, to oneself, and out from there to "living beings everywhere".
Goodwill & Autogenics 4: 24 minutes - a longer version of the meditation given above.